Week 8 - What factors within a country determine sensitivity to the virus?

This is a subject about which hoax “facts” are thick on the ground. Here we will take a conservative approach, confining ourselves to real data, and starting with basic variables.

 

1.     Gender.

Fact: Males are more at risk than females. Explanation: Unclear, but males have higher rates of CVS disorders, higher rates of smoking, but genetic factors are also possibly important. Death in critical care 42% female, 51% male. The issue is unresolved at present.

 

2.     Age.

Fact: Sensitivity to the virus increases dramatically with age: the rate is higher from age 50, and rises dramatically with each decade until 70 – 80.

Explanation: the likelihood of other physical diseases rises sharply with age. Here are three disorders with a strong relationship to age:

 (see 4 (i) below).

 

3.     Ethnic Group.

Fact: In both USA and UK, there are much higher rates in some ethnic groups than others. Some examples of different ethnic rates: The overall rates are different, but data has to be adjusted for other ways that the reference group may differ from the index group. The Institute for Fiscal Studies (IFS) has produced the best study for the UK, and shown that rates for Black Caribbeans have rates three times higher than White British when all other factors, age and ‘geography’ (tendency to choose to live in a high Covid part of the country) are controlled – and Bangladeshis also have double the rate. When this has been done the Bangladeshi hospital fatalities are twice as high, Pakistanis are 2.9 times, and black Africans 3.7 times higher than the British reference group. (Platt & Warwick, IFS, May 2020).  The Office for National Statistics has published a similar study of ethnic sensitivities in early May.(C.White ea covid 19 deaths by ethnic group; RDavies Social impacts of covid10 both from ONS 7th May). 82% have not left their house except for permitted reasons; 40% think crisis will last at least 6 months more; 21% report their relationships have been affectd, especially with their partner.

 

The US Surgeon General, Jerome Adams,  confirms that Black Americans have much higher rates for being Covid cases and for dying of infection than White Americans, and attributes this to higher rates of type 2 diabetes, heart disease and obesity. The Center for Disease Control (CDC) shows higher rates: African Americans also tend to be poorer and less able to practice socially distancing because of the type of work they do and where they live. People from minority communities often live more closely together than in the general population, with extended families mingling in crowded conditions. They are also more concentrated in public-facing jobs such as transport and delivery, as well as health and social care, where they risk greater exposure to the virus.

 

                                                        Whites            Black       Hispanic     Asian

Rate for hospitalization with

 the virus /100K at risk:                    114.6                    217.7          193.3        62.2

Rate for death once

Hospitalized / 100K:                                          45.2           92.3             74.6         34.2

 

For rates above  (S.Garg et al. ‘Hospitalised rates……Covid 19 disease’, April 17, 2020. CDC).

 

In Norway, a subpopulation from Somalia have a rate of covid caseness >10 times that of Norwegians, but this is provisionally attributed to the fact that in this impoverished group’s income is commonly gained by taxi driving, and these journeys include bringing Norwegians back from Alpine ski resorts, themselves known to be the source of those positive for Covid 19.  (Dr S Mohamed, Oslo).

All Norwegians                                     140 / 100K             Covid 19 disease

Somalis in Norway                            1,586 / 100K            Covid 19 disease

 

Explanation:  Please see section 4(i).

 

4.     Other key factors

 

i.  ‘Other’ medical morbidity. Fact:   The immune system weakens with advancing age, especially for type 2 diabetes, hypertension and heart disease. These disorders more common with advancing age, and have been identified with decreased ability to resist Covid 19. .  Explanation:  This is a mere statement of a consistent correlation between the two variables – it does not, and cannot explain why this is so.

 

Age:                                         14-49               50-64               >65

Hypertension                         17.5%             47.4%             78.6%

Cardiovascular  disease        4.7%               19.6%             50.8%

Chronic metabolic disease   21.9%             37.5%             45.3%

 

 

ii. Obesity. Fact: The USA has the fattest people in the world, the UK the fattest in Europe. Explanation: Sugary drinks, portion size, and high carbohydrate and other dietary deficiencies. (Genetic factors might also have a role, but these environmental factors are quite certainly part of the explanation).

 

Iii Poverty. The IFS report identifies ‘geographical factors’ as the tendency of some ethnic groups to choose to live in high incidence areas, and the study controls both for this and for different ages, before making comparisons with the reference group. It is argued that covid 19 exerts its effects in two ways: by exposing an individual to infection and health risks, and by exposing the individual to loss of income. Poverty is seen as an independent variable. For example, in the UK Bangladeshis, Black Africans and Black Caribbeans have the most limited savings. The probability of being in a “shut down” occupation is 3 times higher for Pakistanis and 4 times higher for Pakistanis than it is for White British. (Platt & Warwick, IFS, May 2020). 

 

It should not be thought that these three factors are independent of one another, more than one of these three causes can be present at the same time.  Another concept, released by the ONS this week, is social deprivation. This shows that covid-19 patients are more likely to be. ‘key workers’, to travel on public transport, to be low pay and to show ‘excess deaths’

 

Conclusion:  Much of the variance between ethnic groups is correlated with differences in physical disorders,  obesity and poverty. The US and the UK are both unequal societies – so that poor people in the north of England will live 14 years less than rich people, and the GINI index of social inequality for both countries are high in the UK (34.5) and very high in the US (41.5). These indicators of inequality are related to poor diet, poor housing and pollution.  Black and other minority ethnic groups are also over-represented among dead NHS staff includes consultants, and and so cannot be entirely due to economic factors. The last word has not yet been said about the reason for these increased sensitivities of to the virus, but there is quite a lot to suggest some likely reasons.

 

 

 

 

 

 

 

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